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Warehouse Supervisor
tjpoll@habitatkent.org
616-588-5253
Daniel Quisler
Troy Pethers
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Learn more about our coronavirus (COVID-19) response. | Obtenga más información sobre nuestra respuesta de coronavirus (COVID-19).
Group Interest Survey
Group or Organization Name
Group Contact Name
*
Contact Email
*
Cell Phone for Day of Contact
Group Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Group Type
Faith
Corporate
Student
Civic (Friends, Alumni)
Other
Group Size
Habitat for Humanity of Kent County provides a variety of volunteer opportunities which can vary depending on the group size, age restrictions, season and general availability. Construction opportunities are full day commitments. Should you prefer a partial day activity or volunteers to work in shifts you will be scheduled for specific tasks or in one of our 3 ReStore locations.
Do you anticipate needing a partial day and/or shifts?
Yes
No
Age restrictions apply to certain projects and will be enforced. Most tasks require volunteers to be at least 16 years old. Specific jobs may allow other ages. These restrictions will be indicated by a member of the volunteer services department when a date is offered.
Check this box if I anticipate having members under the age of 16
Days Available
Tuesday (8am-4pm)
Wednesday (9am-4pm)
Thursday (8am-4pm)
Friday (8am-4pm)
Saturday (8am-4pm)
Months Available
January
February
March
April
May
June
July
August
September
October
November
December
Already a Sponsor?
Yes
No
I don't know.
Additional information or comments can be filled below:
Please acknowledge that you understand groups may not be confirmed until 30-60 DAYS PRIOR TO THE DATE AGREED UPON by our volunteer services department. Due to the volume of requests for volunteer opportunities, we will ask that you agree/disagree to the date we offer within a week’s time (unless otherwise noted in our email). This ensures we can look for an alternative date if necessary and place you within a timely fashion.
*
I acknowledge the above statement
After the completed form is submitted expect to be contacted by a member of our volunteer services department within one week.
CLOSE
CLOSE
Homeownership Interest
Name
*
First
Last
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Are you a veteran?
Yes
No
How did you hear about Habitat?
friend/family
yard sign
billboard
advertisement
news story
website
social media
walk in
Phone
Email
*
CLOSE
Homeownership Program Initial Application
Step 1 of 14
7%
Directions
1) Review the three criteria on the following page: Need, Willingness to Partner, & Ability to Pay. All three must be true and you must sign.
2) Fill out the entire application being sure to answer all questions
3) Include the $10 application fee (waived for Veteran applicants) & copies of the following documents as applicable. Please do not turn in your application without the applicable accompanying documentation.
Pay stubs - most recent 30 days worth from Applicant & Co-Applicant showing year-to-date income
Benefit Statements - for any other income sources paid to Applicant or Co-Applicant
Driver's License or State ID - from Applicant & Co-Applicant only
DD214 or VA ID card if a Veteran, or most recent LES if currently serving in military
Need, Willingness to Partner, & Ability to Pay
*Note: All items listed below under the three criteria must be true of the applicant and co-applicant
Need:
‐ Do not currently own a home (owning a mobile home is acceptable)
‐ Current housing is inadequate, overcrowded, unstable, or too costly
‐ Unable to qualify for a conventional mortgage
Ability to Pay
‐ Must be a U.S. Citizen or Permanent Resident (with a "Green Card")
‐ Have 12 months of stable income
‐ Pay rent and other bills reliably & have acceptable credit history
‐ Have ability to save at least $1,500 for a home down payment
‐ Long-term debt obligation is less than or equal to 38% of gross income
‐ Household's average monthly income based on before tax year-to-date
Willingness to Partner
‐ Willing to partner with Habitat by completing 275 to 500
"Sweat Equity" volunteer hours working on Habitat construction sites, taking free workshops and classes, and performing other approved volunteer activities.
‐ Willing to accept available property locations
‐ Will attend all required meetings, workshops, & classes
‐ Will maintain or improve my financial standing while in the program by working to pay off debts
‐ Will participate in the Homeowner Association (if applying for a townhome/condominium)
(YTD) numbers falls within the range below:
Feedback
How did you hear about this program?
Applicant Information
*Note: Taking on additional debt after submitting this application may disqualify you*
Name
*
First
Last
Social Security #
Date of Birth
Date Format: MM slash DD slash YYYY
Phone
Email
*
Are you a U.S. citizen or legal permanent resident?
Yes
No
Are you a Veteran or currently serving in military?
*
Yes
No
Is any other household member a Veteran?
*
Yes
No
Co-Applicant Information (Optional)
Name
First
Last
Social Security #
Date of Birth
Date Format: MM slash DD slash YYYY
Phone
Email
Are you a U.S. citizen or legal permanent resident?
Yes
No
Are you a Veteran or currently serving in military?
Yes
No
Current Housing Information
*If applicant and co-applicant have different addresses, use applicant's and include co-applicant's on a separate piece of paper
Applicant Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Housing Type
Apartment
House
Mobile Home
Family/Friends
Other
Housing Status
Own
Rent
Move-in Date
Date Format: MM slash DD slash YYYY
Monthly Rent
Number of people living in Home
Landlord's Name (or Apartment Complex name)
Landlord's Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Landlord's Phone
Landlord's Fax
Household Member Information
*List everyone, other than applicants, who would live in your Habitat Home
Name
First
Last
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Amount of Cash Assets **
** Do not include retirement accounts like 401Ks
Applicant & Co-applicant Average Balance
Types: Checking Account(s), Saving Account(s), CDs, Stocks, Bonds, Cash
Applicant Employment Information
Employer Name
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone (main line)
Fax
Average Hours/Week
Wage
Start Date
Date Format: MM slash DD slash YYYY
Is this Job Seasonal?
Yes
No
*If you have had other jobs in the past 12 months, use the choose file link below to attach a document with information on those other jobs.
Job Information File
Co-Applicant Employment Information
Employer Name
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone (main line)
Fax
Average Hours/Week
Wage
Start Date
Date Format: MM slash DD slash YYYY
Is this Job Seasonal?
Yes
No
*If you have had other jobs in the past 12 months, use the choose file link below to attach a document with information on those other jobs.
Job Information File
Additional Income Information
*Please check ALL monthly household income amounts for all household members
Type of Income
Veterans Administration Benefits
Social Security
SSI
Child Support
FIP (cash assistance)
Own Business Income
Adoption Subsidy
Foster Care Subsidy
Pension / Retirement
Other
Other
Total Additional Income Amount
Debt Information
*Please list all current debt payments applicant & co-applicant are responsible for paying
Type of Debt
Car Loan/Car payment
Credit Card
Bank Loan
Student Loan
Travel Loan
Pay Day Loan
Child Support
Collections
Other
Total Monthly Payment
Authorization to Release Information: Applicant, co-applicant, and adult household members:</strong> I authorize Habitat for Humanity of Kent County to pull my credit report (applicant & co-applicant only), verify my work history by contacting my current and/or former employer, verify my rental history by contacting my current and/or former landlord, and screen my name against sex offender registries. I also understand that data collected from this application may be used along with other applicant data for statistical analysis. Confidentiality of personal information will be maintained according to Habitat for Humanity of Kent County's Privacy Policy.
*All household members who are age 17 and over should sign.
Applicant, co-applicant, and adult household members:
I authorize Habitat for Humanity of Kent County to pull my credit report (applicant & co-applicant only), verify my work history by contacting my current and/or former employer, verify my rental history by contacting my current and/or former landlord, and screen my name against sex offender registries. I also understand that data collected from this application may be used along with other applicant data for statistical analysis. Confidentiality of personal information will be maintained according to Habitat for Humanity of Kent County's Privacy Policy.
17 year olds:
By signing below, I acknowledge that Habitat will screen my name against sex offender registries. Confidentiality of personal information will be maintained according to Habitat for Humanity of Kent County's Privacy Policy.
Applicant Signature
Co-Applicant Signature
Household Member 3 Signature
Household Member 4 Signature
Date
*
MM
DD
YYYY
Information for Government Monitoring Purposes & Statistical Analysis
Please read this statement before completing:
The following demographic information is often requested by the government to monitor our compliance with equal credit opportunity and fair housing laws. You are not required to furnish this information but are encouraged to do so. The law provides that we may neither discriminate on the basis of this information nor on whether or not you choose to furnish it. If you do not wish to furnish this information, please check the box indicating so.
Applicant
I do not wish to provide any of this information
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian or Alaskan Native
Native Hawaiian or other Pacific Islander
White
Asian
Black/African American
Two or more other Races
Gender
Male
Female
Marital Status
Married
Unmarried (i.e. single, divorced, widowed)
Separated
Co-Applicant
I do not wish to provide any of this information
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian or Alaskan Native
Native Hawaiian or other Pacific Islander
White
Asian
Black/African American
Two or more other Races
Gender
Male
Female
Marital Status
Married
Unmarried (i.e. single, divorced, widowed)
Separated
How does the Application Process work?
Part I - Initial Application:
See the directions on page one for more information. Please deliver or mail your Initial Application, copies of the requested documents, and your $10 application fee (waived for Veteran applicants) to Habitat for Humanity of Kent County. Verification forms will be sent to employers and landlords and your credit report will be pulled. We will notify you regarding your status once your application has been processed and the verifications have been obtained.
Part II - Group Meeting:
If your Initial Application meets the "Ability to Pay" program requirement, you will be invited to the Phase II Group Meeting. We will give you more information about the rest of the process at this meeting. There will be additional paperwork to fill out and additional documentation to provide at this stage.
Part III - Home Interview:
At least two members of our Selection Committee will schedule a home interview with you at your current residence. The committee assists Habitat staff in making recommendations to the Board of Directors regarding who meets program criteria.
Note that the entire application process from Part I to III can take many months. Please be patient with us and feel free to ask questions when you have them.
Frequently Asked Questions
WHAT IS HABITAT FOR HUMANITY?
Habitat for Humanity is a non-profit, Christian based housing organization dedicated to providing decent and affordable homes through the construction of new homes and through the repair of existing homes.
HOW MUCH WILL A HABITAT HOME COST?
Habitat homes are financed with affordable mortgages. We sell our homes for the appraised value as set by independent, licensed appraisers. A minimum of a $1,500 down payment is required of our homebuyers, but we give homebuyers time to save up the down payment.
WHAT SHOULD I DO IF I HAVE QUESTIONS OR NEED HELP FILLING OUT THE APPLICATION?
Please call 616-588-5239 or 616-588-5235. Por favor, llame si tiene preguntas sobre el proceso o el programa.
We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, disability, familial status, age, marital status, sexual orientation, gender identity, or lawful source of income.
Habitat for Humanity of Kent County, 425 Pleasant St. SW Grand Rapids MI 49503. Fax: 616-774-4120 General phone: 616-774-2431
×
Home Improvement Program (Repair Program)
Step 1 of 14
7%
If you are interested in our repair program, please review the following Selection Criteria sheet and then fill out and return the application. Be sure to include all of the required supporting documents that are listed on the last page.
We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, disability, familial status, age, marital status, sexual orientation, gender identity or lawful source of income.
Selection Criteria
1. Proof of Homeownership
‐ Own home in our project coverage area that is your primary residence.
‐ Provide Proof of Homeowners Insurance Coverage (if you don't have home insurance, let us try to help you obtain it)
‐ Be current on property tax payments (to be verified by Habitat through city website) and be current on mortgage payments.
‐ Veteran applicants may apply if living with relative who owns home.
‐ Have no more than $20,000 in cash assets.
Do you live in one of the following neighborhoods?
*
West Grand
John Ball Area
Roosevelt Park
Black Hills
Veteran
Due to funding requirements, Habitat Kent’s repair program only partners with homeowners from the above Grand Rapids, Michigan neighborhoods. If you have questions about your neigborhood location or would like refferals to other home repair services please call (616)-588-5258.
Are you a Veteran?
*
Yes
No
2. Willingness to Partner with Habitat
‐ Complete application package and participate in application process.
‐ Perform required “Sweat Equity” volunteer hours if applicable.
‐ Be willing to accept a forgivable lien against property.
‐ Be present at home the day the work is being completed if possible.
‐ Maintain an attitude of cooperation and treat all stakeholders with respect.
3. Ability to Pay for Repair
- Total household income plus a modest percentage of home value cannot exceed the applicable limit in the chart below (percentage of home value only included when the home is worth more than $153,360).
‐ You must be willing and able to repay up to 40% of the total project cost.
‐ A reasonable payment plan will be offered to applicants who have a debt to income ratio less than 40%. Applicants that are not approved for a payment plan will have the option of paying 40% of the total project costs up front.
AMI limits updated 6/8/18
Note: Habitat for Humanity of Kent County approves repair projects based on critical repair assessments, health & safety needs, budgetary constraints, and location. We reserve the right to decline any potential project that does not fit our stated goals.
We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, disability, familial status, age, marital status, sexual orientation, gender identity or lawful source of income.
Instructions: Completely fill out the application (please complete all blanks). If your application is incomplete, you run the risk of not being accepted into the program. Along with this application, please be sure to turn in copies of all documents on the List of Supporting Documents which is on the last page. Please turn in the application by the due date written on page one. Your application will be kept confidential.
Applicant Information
Applicant Name
*
First
Last
Gender
Male
Female
Social Security # (or ITIN #):
Date of Birth
Date Format: MM slash DD slash YYYY
Phone
*
Email
Co-Applicant Information
Co-Applicant Name
First
Last
Gender
Male
Female
Social Security # (or ITIN #):
Date of Birth
Date Format: MM slash DD slash YYYY
Current Housing Information
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Name of Owner(s)
Is the home paid off?
Yes
No
How many people live in your house?
Are any Veterans part of your household?
Yes
No
If yes, how is Veteran related to the Homeowner?
Spouse
Child
Parent
Niece, Nephew, Aunt, Uncle
Homowner's Insurance Carrier:
Policy Number
Are you current on your property taxes?
Yes
No
Are your taxes & insurance paid through escrow?
Yes
No
Household Information
*Please list everyone, other than applicant, who resides in the home.
Name
First
Last
Relationship to Applicant
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Relationship to Applicant
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Relationship to Applicant
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Relationship to Applicant
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Name
First
Last
Relationship to Applicant
Date of Birth
Date Format: MM slash DD slash YYYY
Gender
Male
Female
Please enter information of any additional household members:
Need
Please place a check mark next to your need(s):
*
Water Heater
Furnace
Roof
Gutters
Exterior
House Painting
Insulation
Entry Ramp
Plumbing
Electrical
Health (i.e. asbestos, lead, or mold issues)
Window/Door
Foundation
Other
If you would like to provide us with additional information regarding your needs, please do so here:
Willingness to Partner
As part of the Willingness to Partner criteria, you will be required to pay a certain amount of the expenses incurred to repair your home. You will also be required to to sign a forgivable lien. Please read the following points carefully:
1. The co-payment will be 40% of total project costs. Sweat Equity can be completed to lower the co-payment to 30% of the total project cost.
2. You will be required to sign a
forgivable lien also known as a forgivable
second mortgage
in the amount of the total project expenses. This lien will be reduced over time and will be forgiven after 5 years as long as you make your agreed upon payments. The forgivable lien helps ensure that you are not taking advantage of the program to repair your home so that you can immediately sell it for profit. Living in the home for at least 5 years after the repairs are complete effectively means the forgivable lien will not effect you at all.
* By signing below, you are indicating your Willingness to Partner with Habitat *
Applicant Signature
*
Asset Information
*Please list all household cash assets (checking & savings accounts, CDs, other bank accounts, cash, etc.) If you have more than $20,000 in cash assets, then you do not qualify for this program.
Bank/Credit Union Name
Balance/Amount
*
Employment Information
Are you currently employed?
Yes
No
If not employed, please explain:
Current Employer Name
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Fax
Type of Business
Position/Title
Average Hours/Week
Wage
Start Date
Date Format: MM slash DD slash YYYY
Please include details on any other jobs in the past 12 months:
Income Information
*Please list all
monthly
household income amounts before taxes and deductions.
Applicant Income Information
Type of Income:
Employment (before taxes)
Unemployment
Venterans Administration Benefits
Social Security
SSI
Child Support
FIP (cash assistance)
Business Income
Adoption Subsidy
Foster Care Subsidy
Pension / Retirement
Section 8 Housing Assistance
Other
Other
Applicant: Total Monthly Income (Before Taxes)
*
Spouse or Household Member 1 Income Information
Type of Income:
Employment (before taxes)
Unemployment
Venterans Administration Benefits
Social Security
SSI
Child Support
FIP (cash assistance)
Business Income
Adoption Subsidy
Foster Care Subsidy
Pension / Retirement
Section 8 Housing Assistance
Other
Other
Spouse or Household Member 1: Total Monthly Income (Before Taxes)
Household Member 2 Income Information
Type of Income:
Employment (before taxes)
Unemployment
Venterans Administration Benefits
Social Security
SSI
Child Support
FIP (cash assistance)
Business Income
Adoption Subsidy
Foster Care Subsidy
Pension / Retirement
Section 8 Housing Assistance
Other
Other
Household Member 2: Total Monthly Income
Household Member 3 Income Information
Type of Income:
Employment (before taxes)
Unemployment
Venterans Administration Benefits
Social Security
SSI
Child Support
FIP (cash assistance)
Business Income
Adoption Subsidy
Foster Care Subsidy
Pension / Retirement
Section 8 Housing Assistance
Other
Other
Household Member 3: Total Monthly Income
Total Household Monthly Income
Feedback
*How did you hear about Habitat for Humanity (please check all that apply)
Friend
Employer
Relatives
Caseworker
Place of Worship
Internet
Television
Radio
Newspaper
Other
Habitat program participant (please name):
Agreement, Authorization, and Release: Applicant and all household members age 18 and older: I am authorizing Habitat for Humanity of Kent County, Inc. (HFHKC) to evaluate my actual need for repairs to my home, my ability to repay the amount agreed upon for repairs, and my willingness to partner with Habitat. I understand that the evaluation will include personal visits (including an inspection of my home). I understand that providing false information is grounds for denial. I also understand that completion of this application in no way guarantees that I will receive assistance through the HFHKC Neighborhood Improvement Program. I authorize HFHKC to pull my credit report and screen my name against sex offender registries. I also understand that data collected from this application may be used along with other applicant data for statistical analysis. Confidentiality of personal information will be maintained according to HFHKC's Confidentiality Policy.
*Please read the following statements carefully and sign - *All household members who are age 17 and over should sign.
Applicant and all household members age 18 and older:
I am authorizing Habitat for Humanity of Kent County, Inc. (HFHKC) to evaluate my actual need for repairs to my home, my ability to repay the amount agreed upon for repairs, and my willingness to partner with Habitat. I understand that the evaluation will include personal visits (including an inspection of my home). I understand that providing false information is grounds for denial. I also understand that completion of this application in no way guarantees that I will receive assistance through the HFHKC Neighborhood Improvement Program.
I authorize HFHKC to pull my credit report and screen my name against sex offender registries. I also understand that data collected from this application may be used along with other applicant data for statistical analysis. Confidentiality of personal information will be maintained according to HFHKC's Confidentiality Policy.
17 year olds:
By signing below, I acknowledge that HFHKC will screen my name against sex offender registries. Confidentiality of personal information will be maintained according to HFHKC's Confidentiality Policy.
Applicant Signature
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Co-Applicant or Household Member 1 Signature
Household Member 2 Signature
Household Member 3 Signature
Household Member 4 Signature
Household Member 5 Signature
Date
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MM
DD
YYYY
Confidentiality Policy
*All information in your application package will be kept confidential
Habitat for Humanity of Kent County is committed to maintaining the confidentiality of non-public information regarding applicants, homebuyers, and homeowners in compliance with the law. Accordingly, board members, employees, and volunteers who are permitted to have access to non-public information regarding applicants, homebuyers, and homeowners shall not disclose any of it to third parties without their consent, except as permitted by law. Access to non-public information (such as personal information, tax returns, pay stubs, income documentation, credit reports, housing payment status and history, etc.) is restricted to board members, employees, and a limited number of volunteers on a need-to-know basis.
Information for Government Monitoring Purposes & Statistical Analysis
Please read this statement before completing:
The following demographic information is often requested by the government to monitor our compliance with equal credit opportunity and fair housing laws. You are not required to furnish this information but are encouraged to do so. The law provides that we may neither discriminate on the basis of this information nor on whether or not you choose to furnish it. If you do not wish to furnish this information, please check the box indicating so.
APPLICANT:
I do not wish to provide any of this information.
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian or Alaskan Native
Native Hawaiian or other Pacific Islander
White
Asian
Black/African American
Two or more other Races
Marital Status
Married
Separated
Unmarried (i.e. single, divorced, widowed)
CO-APPLICANT:
I do not wish to provide any of this information.
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian or Alaskan Native
Native Hawaiian or other Pacific Islander
White
Asian
Black/African American
Two or more other Races
Marital Status
Married
Separated
Unmarried (i.e. single, divorced, widowed)
Neighborhood Improvement Program List of Supporting Documents
Please be sure to turn in COPIES of all of the supporting documents listed here with your completed application. Do not include original documents with your application.
Application completed and signed by applicant & family members age 17 and over
Government issued photo ID for applicant only (i.e. State ID, Driver's license, or Passport, etc.)
DD214 form (Military veterans only)
Most recent bank statements for all bank accounts (checking & savings accounts) or other documentation proving value of your cash assets
Proof of current homeowner’s insurance such as Declarations page (consider asking your insurance agent to email proof to Habitat for Humanity, bgrostic@habitatkent.org. If you need help obtaining home insurance, let us know)
Most recent monthly mortgage statement from your lending institution or copy of your Land Contract as applicable
Certificate of Manufactured Home Ownership (only if you own a mobile home with no mortgage)
First two pages of most recent Federal or State Tax Return showing your Adjusted Gross Income (AGI). If you are not required to file a tax return, please check the following box:
I am not required to file a tax return
Most recent pay stub from applicant, co-applicant, or spouse of applicant or co-applicant who live in house
Other income documentation from applicant, co-applicant, or spouse of applicant or co-applicant which may include any or all of the following:
Veterans benefits statement from VA*
Social security benefit statement*
SSI benefit statement*
Unemployment benefits statement*
FIP (cash assistance) benefit statement*
Pension/Retirement income statement*
Self-employment records or year to date profit & loss statement
Child support – report for the last 12 months from Friend of the Court
Copies of last month's receipts for rent payments if you own rental property or rent out part of your house
Verification of
any other income
(business, public assistance, adoption subsidy, foster care subsidy, pension/retirement, etc.)
*Note: providing bank statements that show the deposit of benefits is insufficient. We require copies of your most recent benefit letters of benefit statements.
If additional adults live in the household (additional beyond applicant, co-applicant, or spouse) please provide a letter stating how much money per month the additional adults contribute toward monthly mortgage payments and basic utilities like electric, gas, water/sewer, & trash
Upload Supporting Documents
Drop files here or
If you are unable to upload digital copies. Please mail or drop-off paper copies to Habitat for Humanity of Kent County 425 Pleasant St. SW, Grand Rapids, MI 49503.
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Daniel Quisler Troy Pethers 